safety guide uganda
TRANSCRIPT
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SAFETY GUIDE
UGANDA
May, 2018 The University of Vermont Larner College of Medicine
Non-commercial use: The material in this book may be used non-
commercially without written permission from the publisher.
Authors: Members of Western Connecticut Health Network/University of
Vermont Larner College of Medicine Global Health Program.
Acknowledgment: The authors would like to express their deepest
gratitude to all the people who directly or indirectly contributed in
preparation of this guide.
Second Edition: May, 2018
TABLE OF CONTENT
TRAVEL RULES 1 ENTRY INTO UGANDA 2 DOCUMENT SAFETY 2 ACCIDENTS/INJURY 2 DROWNING 2 FALLING 3 FIRES 3
NEEDLE STICK INJURY 3 ROAD TRAFFIC ACCIDENTS 4 CRIME 4 ATM SCAM 4 BRIBERY 4 LAW ADIDING 4 THEFT 4 WITNESSING A CRIME 5 DISCRIMINATION 5 GENDER 5 RACIAL 5 RELIGION 6 SEXUAL ORIENTATION 6 ILLNESS 6 ALLERGIC REACTION 6 ANIMAL BITE 7 CHRONIC UNDERLYING ILLNESSES 7 COUNTERFEIT DRUGS 9 FOOD POISONING 8 PHARMACY DRUGS 8 SITE-SPECIFIC ILLNESSSES 8 TRAVELER’S DIARRHEA 9 MENTAL HEALTH 10
CROSS CULTURAL CHALLENGES 9
INABILITY TO ADJAST 10
OBSERVATIONS OF INEQUALITY 10 PERSONAL BARRIERS 11 PSYCHIATRIC DISORDERS 11 NATURAL DISASTERS 12 EARTHQUAKES 12 FLOODS 12 LANDSLIDERS 12 TSUNAMIS 12 POLITICAL UNREST 12 CIVIL CONFLICT 12 DEMONSTRATIONS/PROTESTS/RIOTS 12 TERRORISM 13 THREATS OR VIOLENCE AGAINST FOREIGHNERS 14 VIOLENCE 14 GUN AND KNIFE VIOLENCE 14 PHYSICAL ASSASULT 14 SEXUAL ASSAULT 15 SEXUAL HARRASMENT 15
ANNEXURE PROTOCOL - POST EXPOSURE PROPHYLAXIS 20 PROTOCOL - UPON ARRIVAL TO THE HOST COUNTRY 23
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Travel Rules Dear Participant, Below please find a list of rules that must be followed during your elective away. Please be aware that these are rules, not guidelines, and should be followed at all times. Please review the safety guide for more details.
1. Communication: Someone needs to know exactly where you are at all times.
If you are traveling off campus over the weekends, you must let your supervisor
know exactly where you will be traveling and staying. Please also send the
WCHN/UVMLCOM Global Health Coordinator an email update with this
information so that the residency knows where you are. A good guide is to meet
with your site supervisor once per week to check in and discuss plans.
2. Transportation safety: Do not use any transportations not recommended by
the site coordinator or the host family.
3. General Health: If you are sick, no matter how minor you feel the illness is,
your site supervisor needs to be informed immediately. It is very common for
travelers to make health decisions for themselves, and health can deteriorate very
quickly in these settings. Let your supervisor know immediately, and further
monitoring or decisions will be made from there.
4. General Safety: Avoid protest groups, demonstrations, and volatile situations.
Do not travel alone at night.
5. HIV Exposure: If you think you have been exposed, take your first dose of PEP
IMMEDIATELY. Do not wait to call to report this or ask for advice regarding risk
stratification. Assume any exposure is a high-risk exposure and follow the
protocol.
a. Please DO NOT PARTICIPATE in any high-risk medical procedures, this
includes cesarean sections (where you are at higher risk for a needle stick
because of unfamiliarity with the country’s procedures, lack of OR
experience, etc.) and also includes other emergency procedures. Please do
not experiment and work on skills you are not yet comfortable with in a
potentially unstable situation.
b. Recall The Reductive Seduction of Other People’s Problems: “If you’re
young, privileged, and interested in creating a life of meaning, of course
you’d be attracted to solving problems that seem urgent and readily
solvable.”
We hope and anticipate this will be an unforgettable, educational, and safe journey for you!
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Uganda is one of the safest countries in Africa, and its people are friendly with a strong
sense of religiosity. Cultural sensitivity and respect are integral to traveling anywhere in
the world. Following these guidelines will help make your stay in Uganda safe and
enjoyable.
ENTRY INTO UGANDA
● Instructions ● Passport must have at least one-year validity beyond the date of
entry.
● Visa application, letter of invitation, other necessary documents and $50 fee should be submitted online prior leaving the US.
Please, go to: https://visas.immigration.go.ug, in addition follow
the directions provided by the WCHN/UVMLCOM Global Health
Program Coordinator.
● It is recommended to register online at your home Embassy in
Uganda.
● Warning/
● Anticipated
Problems
● Visitors should obtain a Visa and not overstay their visitors pass,
otherwise they will be subjected to a fine of 30USD per day and
other appropriate legal action including police arrest, prosecution
and deportation.
● What to do in
case of a
problem or
violation?
● Contact your Program coordinator in Uganda.
● Get in touch with your Global Health Officer (GHO) at
WCHN/UVMLCOM and contact the US Embassy in Uganda.
● DOCUMENT SAFETY
● Instructions ● Do not carry a passport on you. If anything, make a copy of it and
leave the passport in a safe place at your residence.
● Warning/
Anticipated
Problems
● Lost/Theft of documents
● What to do in
case of a
problem?
● In case of passport loss or theft, contact the program coordinator
in Uganda and they will help you report to the police and open a
case file.
● It is advisable to advertise your lost passport in a local newspaper
just in case someone found it.
● Report the loss of your passport to your Embassy and stay in
touch with them. Make sure they cancel the passport so that it is
not misused. Follow Embassy instructions to help you obtain a
new passport.
SAFETY HAZARD: ACCIDENTS/INJURY - DROWNING
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Background Facts ● Drowning accounts for 13% of all deaths of US citizens
abroad, most likely due to unfamiliarity with local water
currents and conditions, inability to swim, the absence of
lifeguards on duty, inexperience, and failure to wear life
jackets
● Boating can be hazardous, especially if boaters are unfamiliar
with the boat, do not know proper boating etiquette or rules
for watercraft navigation, or are new to the water environment
in a foreign country
Precautions ● Avoid swimming alone or in unfamiliar waters
● If you are not a good swimmer, avoid water activities
● Wear life jackets during water recreation activities
Warning/ Anticipated Problems ● Drowning
● Because most Ugandans cannot swim, help would be difficult
to acquire in the case of drowning
What To Do In Case of Incident ● When coming up for air, breathe out first rather than breathing
in to maximize oxygen intake
● Because kicking uses lots of oxygen, use your legs wisely
● Panic increases adrenaline release; try to relax and preserve
energy for staying afloat
SAFETY HAZARD: ACCIDENTS/INJURY - FALLING
Background Facts ● Many roads in Uganda are not well maintained, and have
potholes, ditches, and uneven surfaces
Precautions ● Be cautious of potholes and ditches in the road
● Be cautious of slipping during rainy season
● Avoid walking in dim or unlit areas
● Carry a flashlight at night
Warning/ Anticipated Problems ● Concussions
● Dislocations and fractures
● Lacerations resulting from falls
What To Do In Case of Incident ● Seek immediate medical attention
● Contact site director and coordinator
SAFETY HAZARD: ACCIDENTS/INJURY - FIRES
Background Facts ● Bush and electricity fires are common in Kamwenge, caused
by haphazard electrical wiring and poor construction
standards
Precautions ● Avoid placing clothing, paper or other combustible material
near outlets
● Avoid smoking or use of candles
Warning/Anticipated Problems ● Burn
● Smoke inhalation
What To Do In Case of Incident ● Be aware of surroundings
● Stay low to the ground when in smoky environment
● Seek immediate medical attention
● Contact site director and coordinator
SAFETY HAZARD: ACCIDENTS/INJURY - NEEDLESTICK INJURY
Precautions ● Be careful when dealing with needles and other sharps in the
hospitals
● Never recap needles
● Dispose sharps in designated containers
● Wear gloves when performing procedures
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Warning/ Anticipated Problems ● Risk of Hepatitis B, Hepatitis C, HIV, and other blood borne
infections
What To Do In Case of Incident ● Wash affected area with soap and clean water
● Contact the person in charge of Post Exposure Prophylaxis at
your workplace and follow the instructions carefully
● Assume every patient is infectious until proven otherwise
● Contact site director and coordinator
SAFETY HAZARD: ACCIDENTS/INJURY - ROAD TRAFFIC ACCIDENTS
Background Facts ● Dense traffic, poorly maintained roads, and loosely followed
traffic laws pose risk
Precautions ● Exercise caution on roads in Kampala
● Be cautious while street crossing
● Avoid riding on bodabodas (motorcycles) in Kampala; they
are dangerous with high accident rate
● Avoid riding in overcrowded, overweight, or top-heavy buses
or minivans
● Avoid jogging alongside busy roads
● Use seatbelt while in a vehicle
● Use transportation means recommended by your site
coordinator
Warning/ Anticipated Problems ● Bodaboda accidents
● Bus accidents
● Car accidents
● Street-crossing accidents
What To Do In Case of Incident ● Seek medical care if injured
● Contact site director and coordinator
SAFETY HAZARD: CRIME - ATM SCAM
Background Facts ● ATM scam has been reported in Uganda
Precautions ● Use ATMs and banks recommended by site director and
coordinator
● Avoid ATM use at night
● Avoid ATM use alone, when possible
Warning/ Anticipated Problems ● Financial loss
What To Do In Case of Incident ● Report to police
● Notify your bank
● Contact site director and coordinator
SAFETY HAZARD: CRIME - BRIBERY
Background Facts ● Bribery has been documented in Uganda
Precautions ● Avoid traveling alone to help avoid bribery
Warning/ Anticipated Problems ● Workers may directly or indirectly suggest bribes in exchange
for a service in various scenarios
What To Do In Case of Incident ● If with a Ugandan counterpart, ask them to resolve the issue
● If without a Ugandan counterpart, resist if you feel the
situation is safe
● If you feel the situation is unsafe, comply and later notify the
site coordinator
SAFETY HAZARD: CRIME - THEFT
Background Facts ● By far the most common threat to the safety of US citizens
abroad comes from criminal activity
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● Travelers to foreign countries are often viewed as wealthy,
naïve targets who are inexperienced, unfamiliar with the
culture, and inept at seeking assistance once victimized
Precautions ● Do not carry valuable items on your person
● Do not leave any belongings unattended
● Do not wear expensive jewelry
● Keep belongings attached to your person
Warning/ Anticipated Problems ● Theft of belongings when you are not paying attention
What To Do In Case of Incident ● Report to police
● Contact site director and coordinator
SAFETY HAZARD: CRIME - WITNESSING A CRIME
Background Facts ● You may put yourself at risk by directly interjecting in a
crime
Precautions ● For your safety, remain uninvolved in the presence of a crime
Warning/ Anticipated Problems ● Witnessing a crime that compels you to interject
What To Do In Case of Incident ● Do not get involved
● Leave the scene
● Contact site director and coordinator
● Discuss with site director and coordinator before reporting to
police
SAFETY HAZARD: DISCRIMINATION - GENDER
Background Facts ● Gender roles are a major part of Ugandan society and family
life
● Women are the primary child rearers and household keepers,
and their value in society is often based on these attributes,
while men are the primary financial providers
● Despite a movement toward gender equality, particularly in
the cities, the treatment of women in particular scenarios can
be difficult for the American observer to accept
Precautions ● Remember the concepts of cultural relativity and humility
Warnings/Anticipated Problems ● You may feel uncomfortable about the roles and treatment of
women in particular scenarios
What To Do In Case of Incident ● Reach out to your host family members, site directors, and
fellow participants to help you navigate these challenges
SAFETY HAZARD: DISCRIMINATION - RACIAL
Background Facts ● While you are unlikely to experience racial discrimination,
you are likely to be conspicuous and easily noticed if you are
not of African descent
Precautions ● Do not take attention from Ugandans in regard to your skin
color personally
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Warnings/Anticipated Problems ● Being called a “muzungu” (Luganda for “white person”)
● Being asked permission to have your hair or skin touched
● Receiving unwelcome attention on the street
What To Do In Case of Incident ● When addressed by strangers, politely smile and say hello, or
keep to yourself and continue with your activity
● If you are uncomfortable being touched, politely decline
SAFETY HAZARD: DISCRIMINATION - RELIGIOUS
Background Fact ● Ugandans are very religious
● While you are very unlikely to be judged for your religion,
you may be conspicuous as a nonreligious individual
Precautions ● Maintain your religious views as a private matter
Warnings/Anticipated Problems ● Judgment by local friends and colleagues
● Violation of culturally held values
What To Do In Case of Incident ● Reach out to your host family members and peers for support
SAFETY HAZARD: DISCRIMINATION - SEXUAL ORIENTATION
Background Fact ● In February 2014, President Museveni signed the stronger
anti-gay bill into law and 97% of Ugandans concurred with
his decision
● The law has since been rescinded by a Ugandan court and has
not been reinstated
● Some sections of the Ugandan constitution ban same-sex
relationships
● Ugandan traditions and values do not accept homosexuality
Precautions ● Maintain your sexual orientation as a private matter
● For your safety, abstain from same-sex relationships while in
Uganda
Warnings/Anticipated Problems ● Judgment by local friends and colleagues
● Violation of culturally held values
● Violation of some sections of the constitution
What To Do In Case of Incident ● In case of police arrest, contact the American Embassy
● Contact site director and coordinator
SAFETY HAZARD: ILLNESS - ALLERGIC REACTION
Background Facts ● You can unknowingly be exposed to substances you may be
allergic to through the food consumption and medications on
the Ugandan market
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Precautions ● It is advised that you travel with anti-histamines
● In case of type 1 hypersensitivity, carry Epipen all the time
Warnings/Anticipated Problems ● Allergic reaction to a known or unknown trigger
What To Do In Case of Incident ● Take an antihistamine and immediately seek medical care
● In case of type 1 hypersensitivity, use Epipen and
immediately seek medical care
● Contact site director
SAFETY HAZARD: ILLNESS - ANIMAL SCRATCH/BITE
Background Facts ● Scratch and bite wounds can become infected
● Wound care is especially important for tetanus- or rabies-
prone wounds
● In Uganda, rabies is most frequently transmitted to humans by
dogs
● Bats may also carry rabies, although infrequently
Precautions ● Attention to rabies and tetanus prevention is required
● Avoid interacting with stray dogs and other stray animals
Warnings/Anticipated Problems ● Being scratched or bitten by an animal, with potential for
superimposed bacterial infection
● Being bitten by a rabid animal
What To Do In Case of Incident ● Immediately seek medical care
● To prevent infection, promptly clean all bite and scratch
wounds with soap and water
● Promptly debride the wound if necrotic tissue, dirt, or other
foreign materials are present
SAFETY HAZARD: ILLNESS - CHRONIC UNDERLYING ILLNESS
Background Facts ● It is important to ensure access to the resources necessary to
treat any chronic underlying illnesses while traveling
● Refer to the following CDC site for precautions to be taken
for specific underlying chronic illnesses:
http://wwwnc.cdc.gov/travel/yellowbook/2016/advising-
travelers-with-specific-needs/travelers-with-chronic-illnesses
Precautions ● Through your program director, connect with a doctor in
Uganda familiar with your condition prior to departure
● Have a medical checkup before travelling to Uganda
● Have enough medications for your chronic illness to last you
through the visit to Uganda, and some extra
● Ensure that any chronic illnesses are well controlled
● Patients with an underlying illness should see their healthcare
providers to ensure that management of their illness is
optimized
● Provide a clinician’s letter on office letterhead stationery
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outlining existing medical conditions, medications prescribed
(including generic names), and any equipment required to
manage the condition
Warnings/Anticipated Problems ● Flares of chronic illnesses
● Unavailability of some drugs on the Ugandan market
What To Do In Case of Incident ● Seek medical attention in case of a flare
● Contact site coordinator and program director
SAFETY HAZARD: ILLNESS - FOOD POISONING
Background Facts ● Generally, sanitation is poor in Uganda
Precautions ● Do not consume raw foods
● Do not consume unrefrigerated leftover food, particularly rice
● Do not consume unpasteurized fresh fruit juice
● Do not consume food from street vendors
Warnings/Anticipated Problems ● Abdominal pain, nausea, vomiting, and diarrhea for a period
ranging a few hours to days
What To Do In Case of Incident ● Stay hydrated
● Seek medical advice
SAFETY HAZARD: ILLNESS - COUNTERFEIT MEDICATIONS
Background Facts ● Roughly one-third of drugs sold in Ugandan pharmacies are
counterfeit
Precautions ● Only purchase drugs as recommended by site director
● Bring your own medication supply from your home pharmacy
Warnings/Anticipated Problems ● Taking ineffective counterfeit drugs
What To Do In Case of Incident ● Immediately exchange the counterfeit drugs for effective
brand drugs
● Notify site coordinator
SAFETY HAZARD: ILLNESS - SITE-SPECIFIC ILLNESS
Background Facts ● Malaria and Schistosomiasis are the most common site-
specific illnesses in Uganda
● For a complete list, consult
http://wwwnc.cdc.gov/travel/destinations/clinician/none/ugan
da
Precautions ● To protect against Malaria
○ Sleep under insecticide-treated mosquito nets
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○ Take malaria prophylaxis as instructed by your
physician
○ Use mosquito repellent
○ Wear long sleeved clothing especially at night
● To protect against Schistosomiasis
○ Consider all freshwater in Uganda, lakes and rivers,
as contaminated ○ Do not bathe, swim, or wade in freshwater
Warnings/Anticipated Problems ● Acquiring Malaria
● Acquiring Schistosomiasis
What To Do In Case of Incident ● For any febrile illnesses, seek immediate medical attention
and contact site coordinator
● If you do bathe, swim, or wade in freshwater, consult a travel
clinic upon return home
SAFETY HAZARD: ILLNESSES - TRAVELER’S DIARRHEA
Background Facts ● Travelers’ diarrhea (TD) is the most predictable travel-related
illness, with poor hygiene practice in local restaurants likely
the largest contributor
Precautions ● Do not consume raw foods including salad and fruit platters
● Do not consume unpasteurized fresh fruit juice
● Wash and peel fruits before consumption
● Only eat at restaurants with high sanitation standards
● Avoid consuming food from street vendors
Warnings/Anticipated Problems ● Diarrhea
What To Do In Case of Incident ● Follow pre-travel clinic recommendations
● Stay hydrated
● Seek medical advice, particularly if you also have fever or
blood in stool
● Contact site director
SAFETY HAZARD: MENTAL HEALTH - CROSS-CULTURAL CHALLENGES
Background Fact ● You may encounter a myriad of cross-cultural challenges
Precautions ● Try to be aware of your experience with cross-cultural
challenges, and how it may be affecting you
● Use your weekly reflections to process your experiences
Warnings/Anticipated Problems ● Anger
● Confusion
● Cultural shock
● Discomfort
● Frustration
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● Isolation
What To Do In Case of Incident ● Remember the principles of cultural relativity and cultural
humility
● Reach out to your support network, including host family
members, site directors, and fellow participants
● Do not delay in seeking support
● Do not project your anger onto others
SAFETY HAZARD: MENTAL HEALTH - INABILITY TO ADJUST
Background Fact ● Living in an unfamiliar environment can be very difficult and
present unexpected challenges
Precautions ● Try to be aware of your experience adjusting to your host site,
and how it may affecting you
● Try to regularly stay in touch with your home support network
○ There are many accessible means of international
communication, including Skype, Google Chat,
Whatsapp, and Viber
○ You may also consider buying a local sim card or
international package to feel more connected
● Use your weekly reflections to process your experiences
Warnings/Anticipated Problems ● Anger
● Confusion
● Depression
● Discomfort
● Homesickness
● Isolation
● Loneliness
What To Do In Case of Incident ● Reach out to your support network, including host family
members, site directors, and fellow program participants
● Do not delay in seeking support
● Do not project your anger onto others
SAFETY HAZARD: MENTAL HEALTH - OBSERVATIONS OF INEQUALITY
Background Fact ● Observations of inequality can be jarring and upsetting
Precautions ● Try to be aware of your observations of inequality, and how
these observations may be affecting you
● Use your weekly reflections to process your experiences
Warnings/Anticipated Problems ● Anger
● Confusion
● Depression
● Feelings of helplessness
● Frustration
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● Isolation
● Jadedness
What To Do In Case of Incident ● Reach out to your support network, including host family
members, site directors, and fellow program participants
● Do not delay in seeking support
● Do not take out your anger on others
SAFETY HAZARD: MENTAL HEALTH - PERSONAL BARRIERS
Background Facts ● You may have difficulty with a personal issue during your
elective
● This may include relationship problems, family illness, or any
other issue personal in nature
Precautions ● Any personal issues that arise may seem more challenging
while abroad than while at home
Warnings/Anticipated Problems ● Anger
● Depression
● Feelings of helplessness
● Isolation
● Overwhelm
What To Do In Case of Incident ● Reach out to your support network, including host family
members, site directors, and fellow program participants
● Do not delay in seeking support
● Do not project your anger onto others
SAFETY HAZARD: MENTAL HEALTH - PSYCHIATRIC DISORDERS
Background Fact ● International travel can be stressful and has been associated
with the emergence or reemergence of mental health problems
● The availability of culturally compatible mental health
services varies widely
Precautions ● Because laws regarding the use of illicit substances can be
severe in some countries, abstain from illicit substance use
● If you are bringing your own medications for a mental illness
to Uganda, carry them in clearly labeled pharmacy containers,
along with a detailed prescription clearly indicating that you
need this medication
Warnings/Anticipated Problems ● Depression
● Eating disorders
● Mood shifts
● Personality shifts
● Resurgence of underlying psychotic disorders
● Substance abuse
What To Do In Case of Incident ● Reach out to your support network, including host family
members, site directors, and fellow program participants
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● Do not delay in seeking support
● Contact site director
SAFETY HAZARD: NATURAL DISASTERS
Background Facts ● Information on travel alerts and disaster threats is available at
the Department of State website
(http://travel.state.gov/content/passports/english/alertswarning
s.html) and the CDC’s Travelers Health website
(wwwnc.cdc.gov/travel/notices)
● Detailed information on natural disasters can be found at
http://www.redcross.org/get-help/prepare-for-
emergencies/types-of-emergencies
Precautions ● When arriving at a destination, travelers should be familiar
with local risks as well as warning systems, evacuation routes,
and shelters in areas of high risk
Warnings/Anticipated Problems ● Earthquakes: Many parts of Western Uganda, especially the
Western Rift Valley in the Rwenzori Region, are prone to
seismic activity; in 1994, an earthquake hit districts in
Rwenzori region affecting over 50,000 people
● Floods are relatively common in parts of Uganda, especially
during the adverse weather cycle following El-Niño years;
recently, there was a large scale disaster of floods in the areas
of Kasese and Eastern Uganda
● Hailstorms: Parts of Uganda have frequent hail storms
characterized by heavy rains and violent winds; hailstorms
and thunderstorms result in destruction of animals, crops,
human settlements, and public infrastructure
● Landslides: Mountainous areas of the East and the Rwenzori
Region are prone to landslides, accelerated by human
activities like agriculture
What To Do In Case of Incident ● Site directors closely follow the U.S. Embassy’s travel safety
announcements
● Contact your travel/evacuation insurance company
● Stay in touch with site directors
SAFETY HAZARD: CIVIL/POLITICAL UNREST - DEMONSTRATIONS/PROTESTS/RIOTS
Background Facts ● Can include a form of protest against major sociopolitical
problems
● Can include the breakdown of orderly society
● Can escalate into general chaos
Precautions ● Follow the Department of State and US Embassy travel
advisories carefully
● Avoid large public gatherings or protests
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Warnings/Anticipated Problems ● Being arrested and imprisoned by police
● Bodily injury
● Deportation
● Disruption of infrastructure
● Violent riots, illegal parades, sit-ins
What To Do In Case of Incident ● Flee the scene
● Run to a nearby house or shop for refuge
● Contact local program director and local counterparts
● Surrender to nearby police who may take you into safe
custody
● If caught indoors, stay indoors
● In case of police arrest, contact the American Embassy
● In case of injury, seek medical help
● Site directors closely follow the US Embassy’s travel safety
announcements
● In the case of civil conflict, your site directors will inform all
program participants, and will assess the risk
● If risk is high, program participants will be relocated to
another site or returned home
SAFETY HAZARD: CIVIL/POLITICAL UNREST - TERRORISM
Background Facts ● Terrorism has been defined as “the calculated use of violence
(or the threat of violence) against civilians in order to attain
goals that are political or religious or ideological in nature; this
is done through intimidation or coercion or instilling fear.”
● Acts of terrorism have been reported in Uganda
● Acts of terrorism can include bombings, kidnappings and
hostage-taking, armed attacks, arsons and firebombings,
hijackings and skyjackings
● Site directors closely follow the US Embassy’s travel safety
announcements
● In the case of anticipated terrorist action, your site directors
will inform all program participants, and will assess the risk
● If risk is high, program participants will be relocated to
another site or returned home
Precautions ● Follow the Department of State and US Embassy travel
advisories carefully
● In case of anticipated terrorist action, avoid large public
gatherings
● Many initially mistaken gunshots for fireworks; it is in your
best interest to initially assume such a sound is a sign of
danger, and act accordingly
● Cover from view does not mean you are safe; bullets go
through glass, brick, wood and metal
Warnings/Anticipated Problems ● Bodily injury
● Disruption of infrastructure
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What To Do In Case of Incident ● Stay calm and do not panic, but act quickly
● Flee the scene
● Avoid taking public transport or joining big nearby groups;
always assume there will be secondary action
● If you cannot run, try to hide
● Brickwork or cement provides the greatest cover
● Silence your phone and be as quiet as possible
● Contact local program director and local counterparts
● Surrender to nearby police who may take you into safe
custody
● In case of injury, seek medical help
SAFETY HAZARD: POLITICAL UNREST - THREATS OR VIOLENCE AGAINST FOREIGNERS
Background Facts ● Violence against foreigners is very infrequent, but possible
Precautions ● Travel with a Ugandan counterpart whenever possible
● Avoid traveling at night
● Follow state advisories and US Embassy advisories carefully
Warnings/Anticipated Problems ● Violence against tourists
What To Do In Case of Incident ● Site directors closely follow the US Embassy’s travel safety
announcements
● In the case of such threats or violence, your site directors will
assess the risk and inform all program participants
● If high risk, participants will be relocated to another site or
returned home
SAFETY HAZARD: VIOLENCE - GUN AND KNIFE VIOLENCE
Background Fact ● Gun violence is minimal in Uganda due to strict gun control
laws
Precautions ● Avoid walking alone late at night
● Travel with a local counterpart whenever possible
● Be vigilant in recreational spaces involving alcohol
consumption
Warning/ Anticipated Problems ● Assault with a weapon
● Assaulters may be an individual or group
What To Do In Case of Incident ● Avoid eye contact and keep your eyes to the ground
● Keep in mind that resisting without successfully overcoming
the situation can escalate the situation
● Use your best judgement to decide whether to draw attention
to yourself by shouting
● Avoid pursuit of assaulters to risk further injury
● Contact Ugandan program director
● Report the incident to nearby police
● Seek medication attention if injured
SAFETY HAZARD: VIOLENCE - PHYSICAL ASSAULT
Background Facts ● Assaulters may be an individual or group, robbers or
hooligans
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Precautions ● Avoid walking alone late at night
● Travel with a local counterpart whenever possible
Warning/ Anticipated Problems ● Physical assault by an individual or group with or without a
weapon
What To Do In Case of Incident ● Avoid eye contact and keep your eyes to the ground
● Keep in mind that resisting without successfully overcoming
the situation can be an escalator
● Use your best judgement to decide whether to draw attention
to yourself by shouting
● Avoid pursuit of assaulters to risk further injury
● Contact Ugandan program director
● Report the incident to nearby police
● Seek medication attention if injured
SAFETY HAZARD: VIOLENCE - SEXUAL ASSAULT
Background Fact ● Sexual assault is never the victim’s fault
Precautions ● Because thighs are considered an erotic zone in Uganda,
avoid clothing that reveals your thighs
● For your safety, dress modestly, in knee-covering garments
or trousers
Warning/Anticipated Problems ● Non-consensual touching and groping on streets
● Rape
● Unsolicited sexual advances from strangers
What To Do In Case of Incident ● The following options are available to you:
○ Contact program or site director
○ Seek treatment for any injuries, and for prophylaxis
against pregnancy as applicable and STIs including
HIV PEP
○ Contact host family members and/or other program
participants and/or friends for support
○ Contact the American Embassy
○ Contact the international RAINN Hotline at
www.rainn.org for emotional support
○ Contact your home-based rape crisis hotline for
emotional support
○ Contact the local rape crisis hotline if available
SAFETY HAZARD: VIOLENCE - SEXUAL HARASSMENT
Background Fact ● Sexual harassment against women has been documented, on
the street and in workplaces
Precautions ● Traveling with a Ugandan or male counterpart will help
prevent sexual harassment
Warning/ Anticipated Problems ● Sexual harassment in the workplace
○ Inappropriate or otherwise suggestive behavior by a
colleague
● Sexual harassment in public
○ Catcalling
○ Non consensual touching or groping
What To Do In Case of Incident ● Sexual harassment in the workplace
○ Inform your site director and coordinator
● Sexual harassment in public
○ Respond with a firm “no” if you feel it is safe to do
so
○ Seek out a safer space as soon as possible
16
Sources
How To Survive a Terror Attack: Run and Hide- Don’t Play Dead. (2016). Retrieved November 23, 2016 from
http://www.telegraph.co.uk/news/0/how-to-survive-a-terror-attack-run-and-hide---dont-play-dead-say/
The Most Common Disasters in Uganda. Retrieved November 1, 2016, from https://v2040rc.wordpress.com/about-
us/the-most-common-disasters-in-ugandan/
Traveler's Health. (2016). Retrieved November 1, 2016, from http://wwwnc.cdc.gov/travel/yellowbook/2016/table-
of-contents
Types of Emergencies. (2016). Retrieved November 23, 2016 from http://www.redcross.org/get-help/prepare-for-
emergencies/types-of-emergencies
Types of Terrorist Incidents. Retrieved November 23, 2016 from http://www.terrorism-research.com/incidents/
What Should You Do In An Attack? (2015). Retrieved November 23, 2016 from
http://www.bbc.com/news/magazine-34844518
Key Points:
1. Do not travel alone.
2. Do not travel with valuables.
3. Be vigilant of your belongings.
4. Inform your Ugandan program coordinator of your whereabouts.
5. Hire only trusted drivers.
6. Drink only bottled or boiled water.
7. Do not eat cold food.
8. Wear shorts or skirts that cover your thighs.
9. Keep your sexual orientation private.
10. Be respectful of others’ religious beliefs.
11. Do not engage in politics.
17
Important Phone numbers:
1. FIRE: 0421222 / 0714667752
2. Uganda POLICE: 999 / 112
• Useful contacts in Uganda:
o In the event of an emergency, citizens should contact the U.S. Embassy
• Phone: + 256 414 306 001
• E-mail at [email protected]
Host Family Contacts Prof. Sam Luboga
Email: [email protected]
Cell: 0772503275
Christine’s Cell: 0772505565
Office of International Education at
Makerere University
Susan Nassaka Byekwaso
Coordinator of International Programs
Email: [email protected]
Email2: [email protected]
Cell: 0772419313
Office: 0414542999
ACCESS Uganda Robert Kalyesubula
Director ACCESS Uganda
Cell: 0772442700
18
• Useful contacts in the US
US site Director Anne Dougherty
UVMLCOM/WCHN Global Health
Program Director
Majid Sadigh
Cell: 203-885-8895
UVMLCOM Global Health
Coordinator
WCHN Global Health Coordinators
Audree Frey
Cell: 802-656-8378
Joanna Conklin and Laura Smith [email protected]
1-203-739-6341 1-203-739-7543
Occupational Health services
University of Vermont Larner College of
Medicine
Department of Risk Management & Safety
802-656-3242
Global Health Associate Program Director
Mariah McNamara
+1-617-921-0739 [email protected]
AUC/RUSM Global Health Program
Director
Bulat Ziganshin
AUC/RUSM Global Health Program
Coordinator
Dilyara Nurkhametova
19
Business card:
EMERGENCY CONTACTS
1. Sam Luboga……………………………0772503275 2. Robert Kalyesubula….………………. 0772442700 3. Susan Nassaka Byekwaso...…………0772419313 4. Majid Sadigh……………………...+1-203-885-8895 5. Joanna Conklin…………………..+1-203-739-6341 6. Laura E. Smith……………………+1-203-739-7543 7. Audree Frey…………………….. +1-802-310-3156
AMERICAN CITIZEN SERVICES
Plot 1577 Ggaba Road, P.O. Box 7007, Kampala.
Tel: 0414 306001 / 0312 306001 / 0414 259791 Fax: 0414 259 794
E-mail: [email protected]
20
Protocol - Post-Exposure Prophylaxis
In the case of a needle stick and other blood or body fluid exposures, which may occur
while traveling and working abroad, follow the recommendations below. Please note the
following:
1. It is important to run a WHAT IF scenario with your local attending or supervisor
BEFORE an actual needle stick accident does happen.
2. We provide participants with a 7-day supply of PEP. If you are a medical student
at UVMCOM or a resident physician with WCHN, then your PEP supply should be
covered by your health insurance.
STEPS TO FOLLOW IN CASE OF A NEEDLE STICK ACCIDENT
1 Do not panic
2 Remove gloves and wash hands with soap and water or rinse
exposed mucus membranes with water for 5 minutes.
3
Take the first does of PEP and immediately notify your local and US
supervisor (Dr. Sadigh - 203-885-8895, Dr. Molly Moore- 978-828-
6558) and with their help decide if you need to continue prophylaxis
(see Steps A, B, C).
4
If a decision is made that you need prophylaxis, then follow their
recommendation. Be aware of the potential interactions of PEP
with other medicines you may be taking (including oral
contraceptives).
5 Do rapid test on source patient. This may require consent from the
patient. Discuss with your attending local regulations.
6 Do rapid test on yourself and document the results.
7 Begin treatment using your supply of antiretroviral drugs.
8 Notify UVMLCOM or WCHN (203-749-5720) Occupational Health
Services.
9 When you come back, get in touch with Occupational Health to get
follow-up HIV testing at 6 weeks and 3 months after exposure.
21
STEP A. Determine Exposure Code (EC) for Health Care Worker
STEP B. Determine the HIV Status Code (SC) for Exposure Source
22
STEP C. Determine PEP Recommendations
All students with exposure code 1, 2, or 3 who desire PEP are recommended to take the
expanded regimen PEP (2 drugs).
Exposure
code (EC)
Status Code
(SC) for HIV
source
PEP (all courses are for 28 days)
1, 2, 3 1 or 2 Truvada and Aluvia (read package inserts)
This is the expanded regimen in your antiretroviral kit
1, 2, 3 Unknown
Start regimen above until source patient HIV status is known
or for full 28 days if unable to find out source patient HIV
status
Your kit provides a 7-day supply of drugs. If you are advised to complete the 28-day
treatment course, then there will be additional drugs available in the International Office
and/or additional PEP will be shipped to you directly from Walgreen’s Pharmacy at
Danbury Hospital or from the Global Health Office at UVMLCOM.
MOST COMMONLY PRESCRIBED DRUGS FOR
PEP COMMERCIAL NAMES
• Tenofovir (TDF) 300 mg po daily
• Emtricitabine (FTC) 200 mg po daily OR
• Lamivudine (3TC) 300 mg po daily
• Lopinavir 400 mg/ritonavir 100 mg po twice
daily (two 200mg/50mg tablets twice-daily)
Viread
Emtriva
Epivir
Kaletra or Aluvia
Tenofovir (TDV) and Emtricitabine (FTC) are both nucleoside reverse transcriptase (NRT)
inhibitors. They are also sold in a combined formulation called Truvada. Dosing is 1 tablet a
day (TDF 300 mg and FTC 200 mg).
Lopinavir and ritonavir are both protease inhibitors. The combination of these two drugs
comes is formulated under the name Aluvia. Aluvia tablets consist of 200 mg lopinavir and
50 mg ritonavir. Dosing is 2 tablets twice a day (total of 4 tablets a day).
* For the up-to-date recommendations please refer to CDC website
Protocol - Upon Arrival to the Host Country
23
Please put the correct phone number in each box before your departure
Yes No
Is the contact person at the airport? Phone:
Follow his/her instructions
Contact the site program coordinator Phone:
Contact established?
Follow the instructions of the site coordinator
Inform the coordinator at WCHN Call the site program director
Phone:
Yes
No
Contact established?
Follow the instructions of the Director
Inform the coordinator at WCHN
Yes
No
Call the coordinator and program director at WCHN /UVMCOM and
follow the instructions Phone - WCHN: Phone - UVMLCOM:
24
Please put the correct phone number in each box before your departure
Contact the site program coordinator Phone:
Contact established?
Follow the instructions of the site coordinator
Inform the coordinator at WCHN Call the site program director
Phone:
Yes
No
Contact established?
Follow the instructions of the Director
Inform the coordinator at WCHN
Yes
No
Call the coordinator and program director at WCHN /UVMCOM and
follow the instructions Phone - WCHN: Phone - UVMLCOM:
1